lp06.olivepurgetrop.sbs Open in urlscan Pro
104.21.91.152  Public Scan

Form analysis
1 forms found in the DOM

POST

<form method="post" id="ccForm" target="_top">
  <h4 style="display: none; " class="error-text">
    <span></span>
  </h4>
  <input type="hidden" name="form1" value="submit">
  <div class="form-block">
    <div class="form-block__half">
      <i class="far fa-check-circle"></i>
      <input type="text" class="half text-uppercase" placeholder="Imię" name="first_name" value="" required="">
    </div>
    <div class="form-block__half mla">
      <i class="far fa-check-circle"></i>
      <input type="text" class="mla text-uppercase" placeholder="Nazwisko" name="last_name" value="" required="">
    </div>
    <div class="form-block__full">
      <i class="far fa-check-circle"></i>
      <input type="text" class="w100 form-block__full text-uppercase" name="address" placeholder="Adres" value="" required="">
    </div>
    <div class="form-block__half">
      <i class="far fa-check-circle"></i>
      <input type="text" class="text-uppercase" placeholder="Kod pocztowy" name="postcode" value="" required="">
    </div>
    <div class="form-block__half mla">
      <i class="far fa-check-circle"></i>
      <input type="text" class="half text-uppercase" placeholder="Miasto" name="city" value="" required="">
    </div>
    <div class="form-block__full">
      <i class="far fa-check-circle"></i>
      <input class="text-uppercase w100" placeholder="Numer telefonu" type="tel" name="phone" value="" required="">
    </div>
    <div class="form-block__full">
      <input class="form-block__full text-uppercase" placeholder="E-Mail" type="email" name="email" value="" required="">
    </div>
  </div>
  <input type="submit" class="submit-btn button btn-txt" value="CONTINUE" id="submit">
</form>

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